‘Case 7.5Visual Alterations Mrs. Margaret Cooper is a 70-year-old African American female, who has come to Eastridge Family Health Center (EFHC) for an annual physical examination. Mrs. Cooper is a widow who lives alone in a small second-floor apartment and is a retail sales clerk. EFHC admission nurse John Barton conducts a health interview with Mrs. Cooper and notes that Mrs. Cooper is alert and oriented, dressed appropriately for the weather, and answers questions readily and completely. Mrs. Cooper states that she is allergic to dust mites and mold, and takes Claritin-D (10 mg loratadine/240 mg pseudoephedrine sulfate) every day. She reports that she has osteoarthritis in both hips and knees and takes 650 mg of Tylenol (acetaminophen) every 6 hours. She also takes Restoril (temazepam) 15 mg at bedtime for sleep. During the interview, Mrs. Cooper complains of being “unable to see cars coming up alongside when driving,” but denies any eye pain. Mrs. Cooper reveals that she is experiencing “blind spots,” which are darkening and increasing in size and number, and that she is losing visual acuity and is beginning to see “halos” around lights. Mrs. Cooper’s daughter has accompanied her to the clinic visit and notes that Mrs. Cooper has had several small fender bender car accidents in the past year. John performs standard admissions assessments on Mrs. Cooper and notes that she has an absence of the red reflex in the right eye and that her Snellen chart reading is 20/40 (left), 20/50 (right), and 20/50 (both eyes). He observes that she has difficulty rising from a chair, has trouble finding her way from the intake area to the exam room, and collides with the door frame.
